Chang Tung-Cheng, Chen Chien-Chia, Wang Ming-Yang, Yang Ching-Yao, Lin Ming-Tsan
Division of General Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Taipei County, Taiwan.
J Laparoendosc Adv Surg Tech A. 2011 Apr;21(3):215-20. doi: 10.1089/lap.2010.0054. Epub 2011 Jan 23.
Laproscopic surgery is widely used in treating gastrointestinal disease. This study investigated the clinical result, short-term outcomes, and cost analysis of the newly developed gasless laparoscopy-assisted distal gastrectomy (GLADG) and compared it with conventional open distal gastrectomy (ODG).
Seventy-five patients underwent distal gastrectomy with radical lymph node dissection for early gastric cancer from December 2005 to January 2008. Thirty-one patients underwent GLADG and 44 underwent ODG. Postoperative pain, morphine use, disease-free and overall survival, and surgical and hospital costs were measured postoperatively and compared between the two groups.
Patients in the two groups were comparable by age, sex, body mass index, tumor size, tumor location, cancer staging, and operative time. The GLADG group had early start of oral intake and shorter postoperative hospital stay (P < .05). There was less morphine use from postoperative day 1 to 4 in the GLADG group than in the ODG group (P < .05), and body temperature from postoperative day 1 to 2 was lower in the GLADG than in the ODG group (P < .05). Cost analysis showed that operation cost (100,242 ± 5385 versus 36,455 ± 1419) and equipment cost (65,909 ± 5385 versus 2122 ± 1419) was higher in the GLADG group, but its total hospital cost (193,552 ± 12,715 versus 206,676 ± 41,920) was lower than in the ODG group (P < .05). The 2-year disease-free and overall survival rates were not different between the two groups.
GLADG is feasible for early gastric cancer. It is advantageous because of less pain, less postoperative inflammatory response, less blood loss, and shorter total hospital stay while achieving the same oncologic results as ODG.
腹腔镜手术广泛应用于胃肠道疾病的治疗。本研究调查了新开发的免气腹腹腔镜辅助远端胃切除术（GLADG）的临床结果、短期预后及成本分析，并将其与传统开放性远端胃切除术（ODG）进行比较。
2005年12月至2008年1月，75例早期胃癌患者接受了远端胃切除术及根治性淋巴结清扫术。31例行GLADG，44例行ODG。术后测量两组患者的疼痛情况、吗啡使用量、无病生存期和总生存期以及手术和住院费用，并进行比较。
两组患者在年龄、性别、体重指数、肿瘤大小、肿瘤位置、癌症分期和手术时间方面具有可比性。GLADG组患者口服进食开始早，术后住院时间短（P < 0.05）。GLADG组术后第1天至第4天的吗啡使用量少于ODG组（P < 0.05），GLADG组术后第1天至第2天的体温低于ODG组（P < 0.05）。成本分析显示，GLADG组的手术成本（100242 ± 5385对36455 ± 1419）和设备成本（65909 ± 5385对2122 ± 1419）较高，但其总住院成本（193552 ± 12715对206676 ± 41920）低于ODG组（P < 0.05）。两组的2年无病生存率和总生存率无差异。
GLADG用于早期胃癌可行。它具有优势，因为疼痛较轻、术后炎症反应较小、失血较少且总住院时间较短，同时能达到与ODG相同的肿瘤学效果。
